PO-62 | Preventive migraine treatment in patients under 25: a 24-month observational study on adherence, therapeutic switching, and prescription determinant factors

Marilena Marcosano,¹ Nicoletta Brunelli,¹ Luisa Fofi,¹ Laura Papetti,² Fabiana Ursitti,² Massimiliano Valeriani,² Fabrizio Vernieri,¹ Claudia Altamura¹ | ¹Headache and Neurosonology Unit, Fondazione Policlinico Campus Biomedico di Rome, Rome, Italy; ²Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, Rome, Italy

Background: This retrospective cohort study investigated young migraine patients (<25 years) to evaluate patterns of oral and anti-CGRP monoclonal antibody (mAb) prescriptions, follow-up adherence, and monthly migraine day (MMD) trends. It aimed to identify clinical factors associated with follow-up dropout, mAb usage, and migraine worsening.

Methods: The study included 383 migraine patients (77.8% female; mean age: 20.8 years) followed at the Headache Center of the Fondazione Policlinico Campus Bio-Medico, Rome. Non-migraine headaches were excluded. For patients with >8 MMDs, mAb efficacy was assessed by a ≥50% MMD reduction (RR50). Statistical analysis (SPSS) employed logistic regression and chi-square tests to identify predictors of follow-up loss, mAb prescription, and treatment response.

Results: At baseline, patients reported an average of 10.9 MMDs and commonly used NSAIDs (75.7%) for acute treatment, while triptans were underused (5.7%). Preventive therapy had never been used by 62.2% of the cohort; only 18.1% had tried a single preventive regimen. Frequent comorbidities included neuropsychiatric and gynecological conditions. Photophobia was the most common symptom, and stress was the leading trigger. After the initial evaluation, 85.4% were prescribed a preventive treatment—most frequently tricyclic antidepressants (29.2%) and nutraceuticals (21.4%). During follow-up, oral preventives decreased, while advanced therapies like botulinum toxin and mAbs remained stable. Shorter migraine history and fewer MMDs at baseline were significantly associated with dropout from follow-up (p<0.01). mAb treatment for at least six months increased the likelihood of achieving RR50 (OR 2.51, p=0.01), with a better response in males (OR 0.443, p=0.035 for females). Early initiation of mAbs led to more pronounced reductions in migraine burden, although some residual disease persisted.

Conclusion: This young migraine cohort displayed a high burden of disease and comorbidities. Over time, patients tended to adopt more specific acute treatments. Those with milder baseline disease were less likely to adhere to follow-up. Early mAb therapy was more effective in reducing migraine frequency, especially in females, but late intervention resulted in similar minimal MMD levels to those seen with oral therapies.